Members’ Forum – 4 november 2013

November 8, 2013

Rumours abound regarding what the Abbott Government intends to do with Medicare Locals. In the 21 October edition of Australian Medicine, public health expert Stephen Leeder argued dumping the network was a bad idea. One member suggests that, regardless of what happens to Medicare Locals, health services for the Aboriginal community should be funded and controlled by that community.

If they want to keep Medicare Locals for mainstream [health care], that’s their business. All Aboriginal health funding needs to go to Aboriginal community-controlled health services. It is blatantly clear that Aboriginal community-controlled health services deliver a better health service to our own mob than any other service provider in this country. Where there are no Aboriginal community-controlled health services, then they need to be established with the support of their State affiliates and that great Aboriginal community-controlled organisation, NACCHO [National Aboriginal Controlled Community Health Organisation]. If we want to close the gap on Aboriginal health the answer is simple: today we have 150 Aboriginal community-controlled health services in this country; the target by 2030 needs to be 300.Submitted by Sandy Davies (not verified)

When his sister was lying unconscious in a hospital intensive care unit, it was driven home to Adelaide GP Dr Chris Moy just how important an accurate electronic health record could be. Some AMA members voice their opinion on the PCEHR system. “patients and privacy activists had won out over doctors in the tug of war over who would control the health record… this was not the fatal flaw that some claimed it was because – contrary to the myth – patients could not change a shared health summary once it had been created.”

The health summary isn’t the issue. Just because the summary is the only part of the record that is currently functional, it doesn’t mean that this will remain the case – the original plan for the PCEHR was to have a more comprehensive repository of health information. It is the control of the other documents which will be held in the record once it becomes fully functional which is worrying. Concern about patients’ ability to change the record is not a “myth or misconception”. The legislation that underpins the PCEHR specifically gives control to patients as to what documents are included within the record – documents (investigation reports, prescriptions, correspondence from specialists) may be removed without any tracking whatsoever. This is a particular concern when it comes to medications, particularly any medications that have abuse potential. It becomes too easy for untrustworthy people to manipulate the information within the record to support the outcome that they are seeking – i.e. getting a prescription for a drug of dependence. If the information cannot be trusted to be complete, then it cannot be used reliably to make clinical decisions. Considering the increasing harms that arise related to prescription medication misuse (see some of the coroner’s reports from Vic and NSW this year), I find it concerning that the medical folk involved in the process don’t recognise this issue at all.Submitted by Tracy Soh (not verified)

The most important thing for the PCEHR to be useful, is for it to be downloadable in an XML or a database format so that it can integrated into our EHR’s on our desks. I cannot believe that so much money has been spent on such a dog of a system.Submitted by Peter C. Stephenson (not verified)

The fee for a standard GP consultation has been edged $2 higher to $73 in the latest advice issued to doctors by the AMA. One member shares her view.I am assuming the AMA schedule of fees will increase as usual? The rule with the AHSA group of funds is that the known gap for procedures in hospital cannot exceed the AMA fees but the maximum gap is $400.00 with these funds. As the CMBS is not going to increase on 1 November, this means that the maximum gap, when added to the CMBS, will mean the doctor’s expected fee will be eroded. All proceduralists who used the Gap cover scheme and the Known Gap fee will be losing, especially for those patients where the doctor uses Gap cover alone (with elderly patients, or for compassionate reasons), as the funds link their annual fee increases to the CMBS, and this is not going to change. Are the funds going to follow the previous government’s freezing of the rebate? Please let doctors know soon as we need to work out what policy we will adopt from 1 November, i.e. abandon Gapcover completely perhaps, and set our own fees.Submitted by Libby Boshell (not verified)

[AMA notes: The AMA indexed its fees on 1 November as usual. The AMA wrote to every health insurer seeking advice on the timing of their indexation. While we have not received responses from all of them, the responses so far have been varied: some are indexing on 1 November as usual; some are partially indexing on 1 November and again in July 2014; some are not indexing until July 2014; and some do not index annually because they pay a percentage of the MBS fee.

The AMA recognises that if private health insurers index their schedules in November as business as usual, they will be incurring some of the Government’s savings. The AMA applauds those private health insurers that have decided to index their schedules in November to minimise the impact on their members. Those insurers that delay their indexation will avoid carrying the Government’s savings, but will also benefit from a reduction in the growth of their outlays on medical benefits.

As you would no doubt do every year, the AMA advises members to check the insurers’ benefits schedules to decide if you will continue to participate in no gap arrangements and known gap arrangements.]

A current medical student describes their first-hand account of what it is like to have a serious mental health condition while studying medicine. One member expresses her thoughts on this story. You are not alone. I have worked for 30 years with several generations of doctors. Some who were coping well, and others who were yet to be diagnosed. I, too, did some amazing study during my first manic phase. As a postgraduate I shared my story, with a very mixed reception. I, too, was away from work for two years, most of my colleagues learned to let me cry quietly somewhere once a day. We are, as health providers, getting closer to a better understanding of mental health. But as a student, I would still be keeping your fortunate recovery a family and close friend affair.Submitted by Gaye (not verified)